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Time to Change evaluation shows drop in mental health discrimination

Posted on 03/04/2013

A study published in the British Journal of Psychiatry has shown there has been an 11.5% reduction in average levels of discrimination. Led by King's College London's Institute of Psychiatry (IoP), the study of England’s Time to Change anti-stigma programme (run by Mind and Rethink Mental Illness) provides the first evidence that it is possible to change the way the public treat people with mental health problems, but that a long term focus is needed to ensure that discrimination is removed from all areas of people’s lives.

The evaluation covers the first phase of Time to Change, which ran between 2007 and 2011 and was funded by the Big Lottery Fund and Comic Relief.

Dr Claire Henderson, King’s IoP, said: "There is evidence that both the quality and quantity of social contact between people with mental health problems and others is increasing. Our evaluation shows that Time to Change is helping to reduce mental health stigma and discrimination within informal relationships such as friends and family, who are the commonest sources of discrimination. However, we found that mental health discrimination has not yet improved amongst health professionals, including mental health professionals. Our findings suggest that it's easier to influence the way people behave with those they are close to, but much harder to change how people behave in more formal roles or within their professional framework."

There has been a significant reduction in discrimination from friends (14% reduction), family (9%), and in social life (11%) . Within the campaign target audience there has also been a significant increase in willingness to live with someone with a mental health problem in the future (15%) . This suggests that change is happening within personal relationships, and these are all areas which the Time to Change programme has specifically targeted.

It found that 3% more people using mental health services now say that they don’t experience any discrimination at all compared with 2008 . There has also been a clear trend towards improved attitudes among the general public, in contrast to the preceding 10-15 years, in which there was a lack of improvement in public attitudes in England, Scotland and the USA .

Discrimination when getting and keeping a job decreased significantly between 2008 and 2010 , and a survey of employers shows improved knowledge of common mental health problems and more policies in place to support people with mental health problems in the workplace in 2010 compared to 2006 . Changes to public attitudes have been more fragile, with some of the early improvements between 2009 and 2010 dropping back in 2011 . This suggests that the unfavourable economic climate is limiting more positive change, and is consistent with evidence that hostile behaviour towards other groups of people with disabilities has increased since 2010 .

A study comparing newspaper reporting of mental health between 2008 and 2011 found an increase in the proportion of anti-stigmatising articles, but no significant reduction in the amount of stigmatising articles (the proportion of neutral articles decreased) . However, there was a decrease in the proportion of articles about people with mental health problems posing a danger to others, and an increase in the proportion of people with mental health problems being quoted as sources.

People who had seen the Time to Change campaign were more likely to have better knowledge, attitudes and behaviour towards people with mental health problems than those who had not . The campaign has featured celebrities including Stephen Fry, Frank Bruno, Alastair Campbell and Ruby Wax. The evaluation also showed that knowing someone who is open about having a mental health problem (so called ‘social contact’) has a clear and positive impact on public attitudes and behaviour.

Sue Baker, Director of Time to Change, said: “We invested heavily in this evaluation in order to learn from it, as a programme of this scale had not been attempted in England before and no other campaign had looked at behaviour as well as attitude change. So it is really encouraging to see these small but significant changes at such an early stage.

“We know that this is the work of a generation like other issues such as racism and homophobia. That’s why this needs sustained, long term focus, particularly during difficult economic times when so many other factors could be having a negative influence on public attitudes.

“What’s extremely encouraging is evidence of the positive impact of knowing someone who is open about having a mental health problem. This evaluation emphasises that those of us with experience of mental health problems ourselves need to continue to be the major driving forces of social change.”

Time to Change is now in its second phase with funding from the Department of Health and Comic Relief. The uniquely rigorous evaluation is crucial in helping the programme to evolve and shape new work, as well as in aiding the development of other anti-stigma campaigns internationally. The current programme reflects much of the learning presented in these results, including a strategic focus on the media, the extension of social contact alongside social marketing and a pilot project with primary care staff.

Paper reference: 'Reducing stigma and discrimination: evaluation of England's Time to Change programme', British Journal of Psychiatry, April 2013, Volume 202, Issue s55 Edited by Claire Henderson and Graham Thornicroft isfully accessible from the British Journal of Psychiatry

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